Table 3.

PEACH™ QLD implementation challenges and strategies

Implementation challenge	Strategies utilised to respond to implementation challenge			Resulting change
	Interim Review Phase 1: Responding to contractual changes and preparing for pilot.	Interim Review Phase 2: Responding to up-scaling for retention and engagement and preparing for state-wide roll out.	Interim Review Phase 3: Responding to access and equity.
Engagement of the health system and ownership of the health issue	• Stakeholder engagement to align with key health reform policies and strategies in Qld. • Mapped workforce. • Targeted service providers versus individual health professionals. • Designed flexible program delivery model. • Developed standardised Service Agreements. • Consulted Governance Committees to develop cost modelling for program delivery. • Kept abreast of political landscape.	• Issued EOI to engage service organisations to deliver the program. • Engaged early adopters in the primary health care sector to increase diversity of health care settings. • Lobbied for the project to continue with the change in government in 2014 and demise of Commonwealth prevention funds. • Kept abreast of political landscape.	• Issued EOI to engage service organisations to deliver the program. • Advocacy work at Departmental level to endorse the program. • Mobilised strategic advocacy for the program via stakeholder presentations. • Linked with other large scale community-based programs to leverage opportunities. • Promoted program adaptations to encourage uptake from the health sector.	• Requirement of Implementation Team to be flexible and adaptable. • Increased communications with Funding Body to leverage sustainability options.
Recruitment of families and promotion	• Modified targets and milestone dates to align with implementation design. • Created PEACH™ QLD branding and marketing collateral. • Appointed dedicated marketing position. • Established enrolment processes and central intake functions to streamline enrolment. • Accessed demographic and prevalence data to map and profile Queensland to support likelihood of enrolments. • Devised geographical wave approach to implement the program state-wide. • Created database to capture program enquiries to inform future marketing.	• Deployed additional marketing strategies in regional and rural Queensland to reach the target audience and reduce stigma in small towns. • Modified marketing collateral to reflect changes in program design. • Strategically targeted rural areas to run the program to extend reach. • Monitored and adapted marketing and recruitment activities for different regions and holiday periods. • Initiated qualitative research looking at parents’ perspectives on factors influencing their decision to enrol [29]	• Trialled removal of weight criteria in four small communities. • Developed and launched PEACH™ Online to increase reach to families who could not access face-to-face groups. • Implemented online marketing strategy targeting regional and rural Queensland to promote PEACH™ Online. • Removed weight criteria. • Modified marketing collateral to reflect changes in eligibility criteria.	• Investment in marketing strategies which were driving enrolments. • Changes to eligibility criteria and enrolment milestone targets:   ➢ Original eligibility criteria from 7 to 13 years to 5 to 11 years (aligning with typical ages of primary school in Qld), and from overweight only to overweight and obese from Wave 1.   ➢ Removal of weight criteria and eligibility opened to all primary school-age children from Wave 5.   ➢ Revised overall total enrolment target from 1400 to 1100. • Alternative models developed to launch in Wave 5, reported elsewhere.
Participant Engagement - attendance and retention	• Designed and introduced 15 min healthy lifestyle component to child sessions. • Blitzed marketing campaigns 2 months in advance of sessions commencing.	• Referred to Cochrane review [5] to compare attendance data to that of similar national programs. • Reviewed pilot attendance data. • Consultations to gain feedback on content matter, delivery format, frequency of sessions, suite of resources, order of parent sessions and general feedback. • Consulted enrolled families of eight Wave 2 groups to explore how family resources were being used and could be improved. • Reviewed program design and content to better align with families concerns and reasons for enrolment. • Reviewed facilitator training encouraged proactive approach in managing attendance. • Focussed on using community venues such as schools to reduce stigma. • Initiated value-add work on ‘why families enrol in PEACH™ QLD’ to assess motivation to enrol in the program. • Added PEACH™ QLD website functionality for facilitators to record attendance data in real time. • Reviewed child sessions for appropriateness and enhancement for adherence with current Physical Activity Guidelines [37]. • Reviewed content of 10 parent sessions and modified order.	• Initiated value-add work on ‘why enrolled families do not attend’ to further inform implementation.	• Changes to program design:   ➢ Frequency: sessions 1–9 delivered weekly and within a school term (initially delivered fortnightly with no alignment to school term);   ➢ Motivational content SMS messages sent to families between session 9 and 10;   ➢ Three support phone calls more spaced out between sessions 9 and 10 (initially fortnightly); and   ➢ Introduction of SMS reminders to enrolled families 24 h prior to session (Wave 3 only). • Parent sessions reordered. • New edition of Parent Handbook released: language simplified, paper quality lowered, images updated for cultural inclusiveness. • Value-add resources for families sourced. • Goal setting tool introduced. • Child sessions enhanced to address child satisfaction, benefit diversity in child facilitator experience and style, guide delivery of sessions for varying group sizes, levels of complexity, venues and age appropriateness.